title: Self-management approaches for osteoarthritis in the hand: a 2×2 factorial randomised trial.
abstract: BACKGROUND
  Osteoarthritis is the leading cause of disability in older adults. Evidence of effectiveness for self-management of hand osteoarthritis is lacking.
  
  
  METHODS
  In this randomised, factorial trial, we evaluated the effectiveness of joint protection versus no joint protection, and hand exercise versus no hand exercise in adults, 50 years of age or older, with hand osteoarthritis. Following a population survey (n=12 297), eligible individuals were randomly assigned (1:1:1:1) to: leaflet and advice; joint protection; hand exercise; joint protection plus hand exercise. Joint protection and hand exercises were delivered by nine occupational therapists, over four group sessions. The primary outcome was the OARSI/OMERACT responder criteria at 6 months. Outcomes were collected blind to allocation (3, 6, 12 m). Analysis was by intention to treat.
  
  
  RESULTS
  Of 257 participants randomised (65:62:65:65) (mean age (SD) 66 years (9.1); female 66%) follow-up was 85% at 6 m (n=212). Baseline characteristics and loss to follow-up were similar between groups. There were no reported treatment side effects. At 6 m 33% assigned joint protection were responders compared with 21% with no joint protection (p=0.03). Of those assigned hand exercises, 28% were responders compared with 25% with no exercises (n.s.). Differences in secondary outcomes were not statistically significant, except for improvement in pain self-efficacy with joint protection (3 m p=0.002; 6 m p=0.001; 12 m p=0.03).
  
  
  CONCLUSIONS
  These findings show that occupational therapists can support self-management in older adults with hand osteoarthritis, and that joint protection provides an effective intervention for medium term outcome. (Funded by the Arthritis Research UK ISRCTN 33870549).
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
authors.forename: Krysia
authors.initials: K
authors.lastname: Dziedzic
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: Nicholls
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Hill
authors.affiliation: Centre for Health Sciences Research, University of Salford, Salford, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Hammond
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
authors.forename: June
authors.initials: J
authors.lastname: Handy
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: Thomas
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: Hay
mesh_terms: D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D050823:Hand Joints; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000628:therapy*; D055502:Secondary Prevention / Q000379:methods*; D012648:Self Care / Q000379:methods*; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: Hand Osteoarthritis; Occupational therapy; Treatment